The promise of universal health coverage (UHC) is bold: that all people can access quality health services, when and where they need them, without suffering financial hardship.
UHC’s benefits are clear. UHC is central to improving health and well-being. Healthier populations in turn create more productive economies that raise living standards. UHC also strengthens health security by making it easier to contain the spread of infectious disease and respond effectively to natural disasters. UHC will help achieve a healthier, more equitable and secure South-East Asia Region.
Importantly, UHC is feasible: whether a country is rich or poor, progress is possible. Some countries, including in the WHO South-East Asia Region, began their path to UHC when they were low-income. That is a critical point: No-one starts from zero; there are always opportunities to move ahead.
Since 2014 WHO South-East Asia has worked to leverage those opportunities, identifying UHC as a Flagship Priority, and – in consultation with Member countries – implementing a series of game-changing initiatives.
That includes launching the Decade for Strengthening Human Resources for Health 2015-2024, which gives special attention to improving the education and performance of health workers, while also intensifying efforts to retain health workers in rural and hard-to-reach areas.
There has also been increased attention on adapting frontline services to meet the changing health needs of the Region’s ageing population, as well as the growing burden of noncommunicable diseases. This is essential: Apart from the Region-wide shift to more sedentary lifestyles, by 2020 more people in the Region will be over 60 than under-5 years old.
Increasing access to essential medicines is also fundamental. Innovative forms of co-operation such as the South-East Asia Regulatory Network, which pools the Region’s regulatory resources, will help make safe, good quality medicines more accessible. So will new initiatives to improve affordability, such as the Region’s medicines price information sharing platform. Steps towards pooled procurement, starting with antidotes, will especially benefit smaller countries by increasing their bargaining power.
Encouragingly, according to the latest data, essential health services coverage has improved in all of the Region’s 11 Member countries. That is to be celebrated. But Region-wide challenges remain immense. Almost half of the South-East Asia Region’s population still lacks access to essential health services. At least 65 million people are impoverished because of health spending, with medicines being the leading cause of out-of-pocket payments.
Given the Region’s sustained economic growth, accelerated progress is both possible and necessary. Many different players need to be involved. Action across sectors is essential to advance UHC. Within the health sector, priority health programmes clearly play a major role. But to make health services truly universal they must be designed around and for people, rather than around diseases or institutions. Doing so will have immediate and lasting impact.
To that end, increased public spending on health is crucial. Increased public spending will support additional services, and is a pre-condition for improved financial protection. As a Region, government spending on health as a share of GDP remains low. Increasing health budgets is possible even if it is challenging. Encouragingly, since the turn of the millennium five of the Region’s Member countries have done so.
But more money for health is not enough. Money must also be spent wisely. There is good evidence that investment in frontline services is cost effective – all WHO’s ‘best buys’ can be delivered there. Money also needs to be channeled to service providers in ways that are equitable and efficient. There is increasing interest in moving to more ‘strategic purchasing’ in the Region: defining more clearly what services will be delivered, by whom and how providers will be paid. Though this sounds complex, in essence it means organizing health systems in ways that over the right services to the people who need them.
Finally, monitoring matters. Monitoring helps us understand who is being left behind and why. It is essential for accountability. And it helps us learn what is working and what is not, so we can make changes where needed. Member countries have been at the forefront of developing national approaches to monitor progress on UHC and the health-related SDGs. They have also collectively agreed to review progress on UHC and SDG3 (the health goal) at WHO South-East Asia’s Regional Committee every year until 2030. That will prove critical to gauging progress and maintaining momentum.
Today, on World Health Day 2018, I call on all to honour a promise that is bold yet simple, and that will change the lives of millions of people across the Region – health coverage that is universal; health coverage that is for everyone, everywhere and leaves no one behind.
>> Dr Poonam Khetrapal Singh is a Regional Director of WHO South-East Asia Region.
- Prioritize Universal Health Coverage; provide quality health services to all: WHO
- World Health Day - 7 April 2018